D.C. Mun. Regs. r. 22-A2515
The Department shall require all FSMHCs and CSAs certified as a Health Home provider to enter into a HCA with the Department. All payment for services shall be implemented through terms and conditions contained in the HCA and the D.C. Medicaid program.
Only one (1) Health Home provider will receive payment for delivering Health Home services to a consumer in a particular month. A provider may not bill for ACT services for any consumer enrolled in the Health Home.
Reimbursement for Health Home services is on a PMPM rate as published by the Department of Health Care Finance. The month time period shall begin on the first (1st) of the month and end on the last day of the month. In order to qualify for the monthly rate, Health Home providers shall provide and document the required services provided during the month for which reimbursement is claimed.
The Health Home shall provide monthly a minimum of one (1) Health Home service.
For a consumer enrolled in a low-acuity band, the Health Home shall provide at a minimum one (1) care management service and one (1) other Health Home service.
Only one (1) Health Home will receive payment for delivering Health Home services to a consumer in a particular month.
Documentation of all required services in support of any claim for reimbursement under this Chapter shall include the active NPI number for the staff member who provided the service. All claims or attestations seeking Medicaid or local only reimbursement under this Chapter shall include the active NPI numbers for the certified provider and the rendering provider. The rendering provider is the staff member who provided the service.
D.C. Mun. Regs. r. 22-A2515